Healthcare Provider Details

I. General information

NPI: 1013997857
Provider Name (Legal Business Name): DOTHAN ANESTHESIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 W MAIN ST ANESTHESIA DEPT
DOTHAN AL
36305-1056
US

IV. Provider business mailing address

PO BOX 934399
ATLANTA GA
31193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-5000
  • Fax:
Mailing address:
  • Phone: 334-794-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: KENNETH C FLETCHER
Title or Position: PRESIDENT
Credential: MD
Phone: 334-794-5000